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Options regarding kidney function? Lower functioning kidney, stomach pain, got CT scan.

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Opinion on options re: kidney function

Hello,
I'm writing about my father's left kidney condition. He's a medical doctor, ~59 yrs (height-175 cm, weight-77 kg) and has had a lower functioning left kidney for many years. He first discovered it ~6-7 yrs ago, but may have had it from an early age. He has had dull but persistent pain in his stomach as a result. He recently consulted with a urologist, got a CT scan.
Urologist suggested a nephrectomy; my parents also discussed more conservative procedures like pyeloplasty/pyelotomy, vs. removing the left kidney altogether. Doctor’s opinion is that since the kidney function is <20% ( 7yrs ago it was 19%, now it is 18%), it is better to remove the kidney, since it is almost not functional anyway. Just going for a pyeloplasty/pyelotomy might present the possibility of a recurrence in this condition and additional surgery, which in turn might result in scarring and the possibility of left kidney removal again at a later stage.
My mother (medical doctor) & I are of the opinion that if a pyeloplasty/pyelotomy might relieve his pain and condition (and changes of recurrence of the condition are low after this procedure), why go for kidney removal, especially when it is still functioning and presents no issue?
Specifically, I'd really like to know:
a) What % kidney function classifies it as functioning kidney? My mother referred to journals saying 10-15%
b) What are the chances of cure for my father’s condition if we go for a conservative surgery like pyeloplasty, pyelotomy etc?

CT SCAN RESULTS: liver diffusely hypodense; no focal parenchymal lesions identified. Right kidney normal.
Marked left hydronephrosis w/ marked thinning of left renal parenchyma to a depth of only 8mm. Marked dilatation of left renal pelvis to a diameter of 5.2cm. Left ureter is normal in caliber; suspect the patient’s marked left hydronephrosis is secondary to a UP junction obstruction.
No other renal abnormality. Right kidney ~12.3cm in sagittal length; the left kidney ~9.1cm.

Thank you.
Posted Wed, 11 Apr 2012 in Men's Health
 
 
Answered by Dr. Rajiv goel 57 minutes later
Hello.

Thanks for posting the query.

your father obviously has pelviureteric junction obstruction with poorly functioning kidney. An effort can be made to preserve kidney if differential function is more than 15% (as your father has).

Considering your father's kidney function of 15% and the renal parenchyma of 8 mm, which is good indication to go ahead with conservative surgery. Though he may have rare chances of requiring Nephrectomy at later stage, Pyeloplasty still becomes the treatment of choice at this stage.

Renal parenchyma of less than 3-4 mm would form one of the indication for Nephrectomy.

If the patient and the family desires and are aggreable to rare possibilty of second surgery at a later date then pyeloplasty can be done.

I hope, this answers your query.

I will be available for follow up queries if any.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Options regarding kidney function? Lower functioning kidney, stomach pain, got CT scan. 41 days later
Hello Dr. XXXXXXX Goel,

My father underwent a percutaneous nephrostomy a few weeks ago to alleviate his UPJ obstruction. He is contemplating further surgery. He is otherwise healthy and continuing to go to work. Investigations of his blood and urine are normal. However, he has been complaining about excessive tiredness after routine daily work, since his nephrostomy procedure.

Could you kindly advise on whether his tiredness is related to the nephrostomy procedure in any way?

Thanks.
 
 
Answered by Dr. Rajiv goel 2 hours later
Hello.

Thanks for writing back.

Tiredness is probably not related to his Nephrostomy procedure.

I would suggest you to get his blood counts ( TLC, DLC) done to see whether he is having any infection subsequent to the procedure and it may be the cause of his tiredness.

I would like to know how much urine he is producing through nephrostomy?

Hope, this answers your question. Please accept my answer in case you do not have follow up queries.

Regards.
Above answer was peer-reviewed by
 
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